Hello good afternoon everyone. Welcome to the new master. Health Forum here at the McMaster University in Hamilton Ontario as our latest in our series of webinars from our Queen Elizabeth scholars. Our agenda for today's webinar is to give you a quick summary of what the McMaster Health Forum is what the Queen Elisabeth. Scholarship programme is and then. I will turn it over to our Queen Elizabeth scholar or present presenter for today goes Jean and she will be joining us remotely and she will tell you where she is when we get to her. The new master help forum is a leading hub for improving health outcomes through collective problem solving the harness information convene stakeholders and prepare action-oriented leaders and act as an agent of change by empowering stakeholders the Queen Elizabeth scholarship program is run by a partnership between the RIA Hall Foundation and community foundations of Canada universities Canada and Canadian universities the purpose is to activate a dynamic community of young global leaders across the Commonwealth to create lasting impacts both at home and abroad through cross cultural exchanges encompassing international education discovery and inquiry and professional experiences the version of the Queen Elizabeth scholarship program that we offer here the master Health Forum is strengthening health systems. Our scholars will contribute to strengthening health systems and become part of our large and growing network of health system leaders. We have currently had two different cohorts of scholars. Our first cohort is listed here. We had 13 scholars who went away primarily in the calendar year of 2016 and currently our second cohort which comprised of 22 people are currently doing their webinars throughout this fall term and our third cohort will be getting ready to go away in 2018 our presenter for this webinar is Jean who was at the time of her internship at the HSE undergraduate students here at McMaster University. Her research experience had fostered an interest in chronic disease management health system strengthening and her goal for her internship was to strengthen her understanding of health systems research and how it can be utilized to address pressing health issues.

Jean is no longer here at McMaster. She's at the University of Ottawa in the MD program so Jean without further ado. I'm going to turn it over to you for the rest of the presentation. Thank you so much genes for for the introduction and. I'm really happy to be here to present today about my project in Melbourne Australia so I worked with the Australian prevention partnership center and it's an interesting model for research organization as it's a national cooperation of researchers and policymakers and practitioners across the country so there are researchers based in Melbourne and Sydney and in various different institutions that collaborate with each other and this organization hosted by the Sachs Institute so specifically I were John the prevention tracker project learning from local data to activate systems for chronic disease prevention and we were based in Deakin University in Melbourne at the Burwood campus and specifically my project was focused on exploring barriers to community partnerships for funding so for this presentation then I'll go over a little bit about chronic disease prevention in the background of it in Australia. I'll talk a little bit about prevention tracker as a whole the project as well as the study methodology of the literature review that I did and then the results of discussion from that project as well as key personal reflections and lessons for my qts experience so chronic disease in Australia is a major problem it's responsible for 83% of all premature deaths in Australia and it accounts for over 60% of the disease burden so when I mentioned chronic disease we're talking about heart disease stroke heart failure. Chronic kidney disease long disease type 2 diabetes all these conditions that you know progress over a long period of time and can be impacted by various environmental and lifestyle factors and now this is this issues also going on in in Canada as well but the difference here is Australia spends around 2 billion dollars prevention each year or $89 per person now it sounds like a lot in total but this is actually considerably less than the other OECD countries much less than Canada and what the US spends and overall.

It's actually only one point. Three four percent of total healthcare spending which which is interesting because you know a lot of studies now they talk about how if we invest in prevention. Now we save a lot of money in treatment and health care spending leaders down the road whether or not this is actually you know says that you should be spending more on. Prevention is actually complex complex question which brings me to my next point. That prevention is complex. So currently there's a focus on individual behavior change in the space. You know programs that tell people to exercise more to run to eat healthy physical activity programs at the gym. However we're currently living in obesogenic environment in which calorie dense foods are readily available. You know 200 years ago you can just go into the grocery store and get a bunch of or go to the fast food market and have all these unhealthy foods at our fingertips also. We're finding that physical activity guidelines are really difficult to follow with the sedan-chair sedentary lifestyle that society promotes so the environment has really changed and influenced the way that we make health choices and also social determinants of health play a huge role as well so your education level poverty. You know your working conditions. They heavily influence the lifestyle choices of an individual for example. If you're living in the center of a very urban area you may be living in a food. Desert in which you don't have access to healthy foods in grocery stores and fresh foods so when we're running these programs telling people to exercise more or physical activity programs and/or healthy eating programs.

They're very very important. But they also don't address the root causes of the whole whole system of that contributes to obesity and these chronic diseases and so there's a need to examine prevention using a system approach. So what do. I mean when I say a systems approach so a system is the textbook definition is that the regularly interacting or interdependent group of items forming a unified whole and so the way I think about it is that a system is generally synergistic so that means some of its parts the whole is greater than the sum of its parts so one plus one equals three or for example if someone asked you you know what's a cake if you just talk about it you just described it as notes. It's two eggs plus three cups of flour plus two cups of sugar. You're not really doing justice to the whole or to the the concept of a cake in the same way. Systems thinking examines these systems as a whole not just the parts but how these parts interact together the relationships between them their boundaries the different perspectives within a system how they interact to create the system that we see today so one thing that we can use to analyze systems are called the loop diagram so for example depicted here is the system of tobacco consumption so you can see here that there are elements of various players in the system you know the tobacco industry tobacco research the government and the arrows depict the relationships between all these different factors whether they're positive you know they contribute to each other or they're negative one increases and other decreases and so you can see here that it's quite complex but it's not just you know there's individual behavior deciding to the smoker or deciding to quit but then there's also all these factors around it that contribute to that and also when we think about systems framework that we often look at is B WH o health systems framework so this describes all components of the system building blocks so for service delivery this is talking about health interventions delivering them to those who need them where needed in an efficient safe and effective way.

The health workforce are those people that are involved with delivering services and it's important to consider the relative numbers. Are there enough staff. Are they distributed in a effective way so are there enough. Staff in rural versus urban areas are they competent responsive and productive health information systems are very important they ensure that we look at the production analysis and dissemination of health information on how the health system is improving or not improving as well as medical products vaccines and technologies. We see here that while a lot of the other components of the health system might be functioning if we don't have the drugs or the technology technologies to treat people. Then it'll definitely raise some issues. House financing refers to how we pay for services whether it's public private how people access these services and whether financial catastrophes would impact that and then finally leadership and governance what are the policy frameworks that exist to to oversee the health care. Kingdom and all all of these components work together and influence each other in order to improve how make sure that we're responsive to health care needs contribute to social financial risk protection as well as do this in an efficient way so in terms of my project in Australia I was working with the prevention tracker team and this project focuses on local prevention systems in communities so we worked on a community level and basically we mapped out or asked the question of what do local prevention systems look like so looking at what are the policies and programs that are currently in the prevention system as well as the other elements that influency the chronic disease prevention system at a local level and then once we have that information understanding or looking at you know what are the what is the potential that's already there what capacities are you there and what can be done to harness that capacity and build on the system you so there are various components of prevention tracker.

They do a systems inventory of health and well-being programs so looking at all the programs policies and regulations that effect the effect chronic disease of the citizens of the community they also map out indicators of livability so things like how many grocery stores are in this this vicinity. How many green spaces places that sell alcohol as well as they do a community snapshot which looks at the health status of the citizens so what's the rate of obesity or alcohol abuse issues like that. There's also an organizational network analysis that is conducted. And this basically quantifies and looks at the number of organizations that are connected to each other across the community and how densely connected or how often these organizations work together and then there are key informant interviews where basically we have researchers that go into the field and interview stakeholders that are involved in prevention in the community and ask them. You know what's going on right now. What are things that could be improved and what's being done well right now so prevention tracker is currently occurring in four communities across Australia. You can see that they're they're spatially quite far from each other and the first community that signed up is Leonor key it's actually just off of Tasmania has a population of 10,000 people so it's quite a quite a small town and it's a little bit colder than the rest of Australia being that it's located a little bit more south there's Albany which is in Western Australia located on the other end of the country it has a population of about 300,000 which is still quite small but much larger than Milwaukee there's also Broken Hill which is located in the state of New South Wales Broken Hill is located in the Australian outback considered a rural town in the desert and then there's Gold Coast which is six hundred and forty thousand people which is much greater than the other Street communities and it's actually a Malta metropolitan city just off of the coast of Queensland had the opportunity to go there and it is beautiful it looks like Miami it's actually it indeed is a golden toe so my project focused on some of the research findings that came out of prevention tracker and Albany so on the diagram on the right this is a graphic that was produced just synthesizing the main research findings from the project in Albany so that they could you know present the results in a comprehensive way to the community in a way that's interactive and easy to follow so you can see here some of the interesting findings you know stats about the population.

Also something that they found was that you know. 70% of the people in the community shown in the top left of the diagram. 70 percent of people are overweight or obese but in fact four out of five people rated their health as a great or excellent so there seems to be a mismatch there. And you can. You can take a look at this after the presentation as well if you'd like so in terms of the investigation in Albany we found. There's a disconnect in terms of some of the findings and so that produced a research question which based which I based my literature review off of so so they did an organizational network analysis which identifies and quantifies the relationships between organized relations in a community so they sent out in the survey to various governments organizations local organizations community groups and then ask them about their relationships with other organizations in the community and then these diagrams shown here were produced to depict the relationships so so you can see here that the network of resource sharing between organizations is fairly densely connected so that organizations there are a lot of lines in between the organization's each dot represents an organization each line represents a connection between them and you can see that there.

It's quite dense and on some diagrams that aren't shown on this slide. They also showed that that organizations were really well connected in terms of awareness of each other information sharing and other aspects however in figure 2 you can see here that the network of joint funding relationships between organizations were much less with much less dense. You can see a lot less lines in between the organization's so the question arises you know what makes joint funding partnerships different especially because you know in order to achieve large-scale impact often organizations apply for funding together to to watch large initiatives. So what what. What causes this. Disconnect they also did key informant interviews which reflected a very similar thing they showed that informal networks and relationships were important in getting things done and organizations often noted that they often felt external pressures to partner with each other yet. They found it really difficult to do so and they found that they didn't have the time or that they found. It was very difficult to to partner for funding. So that's where my project came in so basically. I looked in the literature to gain a deeper understanding of what are the barriers to community partnerships for funding. And what what might be happening on a community level so in terms of the literature search. I used words such as community collaboration partnership funding a grant and search databases of Scopus as the host ProQuest and basically the initial search pulled up 489 results 38 were selected after title and abstract screening and then 17 were included in the final study and in terms of articles we wanted to focus on not just articles with an aquatic disease prevention but also partnership in terms of social services and/or health promotion because they might they might have some findings that are applicable to our our situation as well we looked at articles talking about partnerships on a community level so not not including state or international level we included the most recent literature since 2010 and include a variety of article types we excluded articles that talked about partnerships in Canada in countries such as various countries in Africa without comparable health systems to Australia and we also excluded articles that focused on research partnerships because those partnerships the nature of those partnerships are a little bit different than the ones that we were interested in and so what could the literature show so in terms of key themes from the literature.

They showed that there is an increasing movement towards using grants to promote inter organizational relationships so a lot of grants would require organizations to partner with each other in order to apply. So they you. You're eligible for this grant if you are partnered with two other organizations however they found that this method was not necessarily this is generating pressure to partnership but it wasn't necessarily supporting synergist energetic productive partnerships and the barriers to these partnerships were located at two main levels challenges with the the funding structure as well as challenges at the organizational and community level so in terms of the funding structure barriers so they found that grassroots emergent partnerships are very different from top-down organized partnerships so what I mean by grassroots partnerships are organizations in the community. They see like a gap or a need and they identify possibly that you know. We don't have the capacity within our organization to address this gap but organization be over there does and so we reach out to them and fueled by that passion. In that need they start to collaborate with each other whereas these top-down organize they organize partnerships for example would be ones that are mandated by grants or such and those grants could contain like restrictive requirements for the partnerships.

And they're not as organic as the ones that emerged bottom-up they also found that funding can formalize partnerships and require partnerships to meet certain demands. That aren't that are that are difficult to meet. Also grants often occur in short funding cycles a couple years whereas you know relationships between organizations. Take time to develop just as it takes time to you know foster a relationship between a co-worker just because of funding cycle ends. Does it mean that it's difficult to you know. End a relationship as as a funding cycle heads also organizations that do similar things are expected to apply for the same pool of funding. So even though they're aiming toward the same goals this causes them to view each other as competitors rather than collaborators. And this can this can change the dynamic between community organizations on a community level. There often isn't enough organizational capacity to partner for funding partnerships. Take a lot of work meetings. Making sure that everyone's on the same page and moving this up to the grant level requires a lot of meeting requirements in terms of writing grant proposals submitting indicators and updates to the grantees and grantor and this this can cause a lot of strain for organizations and given that a lot of community organizations are very pressed with daily tasks partnership development might not be on the top list of their priorities as such and also the last point is I guess not all partnerships are meant to to reach the stage of partnership for funding partnerships and funding usually occurs in the later stages when organizations work together and they they start realizing that we work really well together and it's indicative of partnership maturity so not every partnership is meant to reach that stage so in conclusion or I guess the results of the study you know showed that that partnerships face a lot of barriers in terms of applying for funding together but more research is required to gain a deeper understanding of these barrier and identify solutions but what's interesting is that communities in the prevention tracker project are also not just Albany other communities are also identifying similar issues this is a diagram from the model building session in glenorchy Tasmania where they talked about issues of funding and collaboration and how difficult it was to support funding collaborations so in terms of key lessons that I gained from the experience I've organized them into five main points so the first one is I would say that when I was first thinking about systems thinking it was very it was very overwhelming I understood the concept from it but making sense of a whole complex system like in my mind it was like this jumble of blue arrows it was very very complicated to me and I didn't really make sense of it and in this throughout this internship I think it really helped me gain the tools to to understand system thinking in a functional way although we'll never fully understand systems and the complexities of them tools such as building these causal weak diagrams or group model building sessions helped me to understand how can we think about a system in a functional way and use that to inform inform something also I saw the importance of advocating for chronic disease.

Prevention prevention is something that's difficult to invest in because it's it's not a flashy thing you know investing in cancer cancer treatment people you can say all we save the lives of this many children or you can tell the story of a child who saved and so it generates a lot of media attention but prevention. No one's going to thank you for you know. Thank you so much for preventing me from becoming obese. You don't really see stories like that and so prevention needs to be advocated for and also the results of investing in chronic disease prevention.

Don't happen many years down the road. Let's say ten years and if political cycles are for years it's very difficult to generate the results that politicians or various government officials require in order to you know invest in prevention and so because prevention is so difficult to invest in. But it's so important to do so. We need to advocate for it in the recent sorry the previous Australian election they actually cut a lot of the prevention budget and change the whole prevention space. So that was a that was a big lesson for me also. I think I gained a deeper understanding of the Australian versus Canadian healthcare system the Australian system uses a two-tiered system where there's private and public involvement in terms of provision of hospital based care and care delivered by physicians aware as Canada has mainly a public system financed by the provincial and federal governments in order to deliver hospital based physician provided care and so seeing the dynamics of that and how that influences care was very interesting to see furthermore I learned about the importance of common language so when I first attended a couple meetings in Melbourne and they often talked about all we need to invest in common language of prevention and I thought that was great. Like it's really important but why didn't he. I didn't really fully understand why we needed to spend so much time thinking about the words that we use to describe prevention. We could just use that same amount of time to you. Know invest in running more programs but as the internship went on. I realized how important common language was. And it's not just about the words. It's about common understanding. If we don't have the words or the common understanding to talk about something it's going to be very difficult to collaborate with other people and to understand what what they mean when they talk about prevention and so to make sure everyone's on the same page developing a common language for prevention be very important and finally.

I learned a lot about working with communities not just in communities. I always learned about community work in some classes related to community-based participatory research however this experience helped me really witness the impacts of it. You know when we work with communities just not not coming in with any assumptions and realizing that each community is so different. I had the opportunity to visit Tasmania as well as Broken Hill and Gold Coast and just seeing that each community is so different that even though prevention trackers essentially the same project the way it rolls out in each community is so different and each each area has a local advisory group of various local stakeholders that actually meet with us regularly to talk about that how they see the project rolling out and they help us inform how to carry carry out prevention tracker in the various communities. So it's very important to listen to the voice of locals and and yeah so overall system thinking can be applied to chronic disease prevention in order to understand its complexities. My study showed that community organizations face various challenges when partnering for funding and these challenges they occur at both the organization level as well as a higher level created by funding structures and future research is required to gain a deeper understanding of these barriers. So yeah thank you so much for listening to my presentation and feel free to ask me any questions excellent. Thank you very much team. That was very informative for those of you who are online. I'm gonna ask you please type your questions into the chat box that you see in WebEx for those of you who are joining me here in the room they've been there MassHealth form just put up your hand and we'll have you ask the questions and I'll repeat it online for those who are online and for the recording for a YouTube later.

I will ask the first question to you while people are thinking so. I was intrigued by the fact that the prevention tracker looks at four different communities within Australia and I'm just curious how those four were chosen. They all seem to be slightly different so I'm just wondering if they are weren't selected because they as a whole represent the different facets of a Australian society or was there other reasons why they were selected. Yeah that's a great question so actually. The prevention tracker team didn't select the communities the communities themselves heard about the project and reached out to the prevention tracker team. And said you know we want to see this in our community and so that's kind of how it started. In terms of prevention tracker it was actually rolled out as a pilot project in glenorchy and then they expanded it just recently this year to the three other communities. That's happened yet and you get a sense while you were there that there may be expansion to other parts of Australia so I noticed that obviously the northern part of Australian was notified sent yeah so I think the Australian prevention partnership center is currently undergoing some some structural changes because it just gained some new funding and so right now in terms of the prevention tracker project. They're not quite sure about the future of the project. They're hoping that it can be expanded. But they're not sure in what form or in what shape or form so actually they're not sure at the moment but I'm sure we'll find out a couple months from now thank you so. I'll ask again if anybody has any questions that you're online please. Type it into the chat box. Anybody in the room up. We do have one question in the room so go ahead and I'll repeat it for those on line so we have a question from a Kiwi scholar who also spent some time in Australia and she wants to know if any part of your work looked at the unique needs of the indigenous populations in Australia but I noticed that when I went to the Broken Hill the indigenous issues were very were a very big topic of focus in the community and so some of the organizations that were included in the organizational network analysis as well as the the stakeholder interviews they were involved in the indigenous health so yeah but unfortunately we didn't focus specifically on that great.

Thank you so we have a question online. We actually have a series of questions from the same individuals. I'll read all the questions and I'll let you answer them as you see fit so have you noticed any trends in the various Network Maps example resource sharing funding collaboration cetera. Was there consistent key player either connected in the network and if so what do you think are the characteristics example. They are a prominent stakeholder that put them in that position. Oh Thank You Christy for your question. Yeah so there are so in terms of let me go back. They do differentiate between the central organizations as well as the peripheral organization so the central organizations are shown in red those are the ones that are more connected and more central and then the ones in the the periphery are are less so unfortunately because of confidentiality reasons we don't we try to keep all the organization's anonymous in the in the the organizational network analysis survey so I can't can't say which stakeholders were the ones in the center but yeah we did look at patterns of who was in the center. Who wasn't so. We have another question from someone online so. I'm curious about how you found Australia in. General what did you do for fun to do anything did anything about Australia surprise you. How do you think your experience compares to those of TUI scholars from the first cohort who also went to Australia. A great question. I personally. I loved my experience in Australia. I had the opportunity to travel across Australia and see the various different parts. Oh it's it's so different from the south to the north.

Tasmania is this this country. Sorry this state with so many national parks wilderness mountains. I did a lot of hiking by myself. Where is that. Gold Coast is basically like Miami like I would be on the beach just chillin it was. It was really really nice so yeah in that sense. Australia is kind of like Canada and that it's it's very different from one side to another anything about Australia surprised me. I think I think the initial thing that really surprised me was and accent. I know that's not a very sophisticated answer but I think just like customizing myself to to the accent as well as they have a lot of little like sayings and slang words that I wasn't used to so often they would add IES to the end of words so for example they'd call biscuits stickies or you know sometimes. I have to say pardon me can you. Can you repeat that please because I couldn't understand in terms of experience. Different from the first cohort. I think what was a little bit different as that. A lot of the QT scholars in the first cohort were based in Sydney Australia and I was in in Melbourne and so I think Melbourne was a really really neat place to be because it's like a very cultural City like filled with many little laneways street arts lots of buskers and artists and i had the opportunity to go to Sydney as well but I felt Sydney Sydney was beautiful like beautiful Harbor and stuff but I felt it was a lot more like businessí and it had a different kind of vibe than then Melbourne did so yeah thank you any other questions and again if you're online please type them in the chat box anybody in the room have a question before you put your hand up while we're waiting Krista 13 I was looking Christie's the question being you know I asked you to keep an eye out for something before you went to Australia so now I'm gonna ask the question. Did you see one so. James asked me to take a picture of a Tasmanian Devil for him and in fact I did see one the first one is always a statue of one in the in the airport but I actually did see one when I was in.

Tasmania a real one. I was driving late at night. It was very very dark out and one of them actually like stopped in front of my car so don't worry it was okay and I was okay but yeah it was. It was kind of like deer in headlights on the road for a bit so that was the only time. I got to see one but yeah it looks like a little bit of a large black rodent. I'm quite an interesting interesting animal okay so I'll assume I didn't get a picture of one because of the circumstances yes yes for sure but it was quite scary in the moment. That's completely understandable. Anybody else have any questions either online. They're in the room a pause so I will assume silence means everybody feels comfortable with where you're leaving in your gene so I want to thank you very much for taking the time to log in remotely and complete your webinar. It was very informative. I'm sure everybody enjoyed it. We currently actually have a student in Melbourne as part of our curious scholarship program so picking up where basically where gene left off at the retention tracker group so gene has paved the way for other scholars. And we appreciate the work that you've done just draw your attention to the screen right now really quickly a couple of links that. I would like you to pay attention to if you're interested in applying to our cumulative scholarship program here at McMaster that first link has all the information you need if you want to know all about our webinars and presentations that we have throughout this term and we will be doing this every week for the most part Wednesdays at 4:00 with the odd exception please go to that second link and get the full list of webinars and the links to them and lastly all of our queen of the scholars write a blog to talk about their experiences what they went through different from different perspectives so please visit the blog page and read what our scholars have to say about their experiences.

They're quite enlightening and informative and thank you everybody for joining us thank you again. Jean for doing your presentation and we look forward to seeing everybody again really soon. Thanks a lot.